Manage credentialing activities, including application review, primary source verification, and provider enrollments and re-enrollments with contracted payers. Direct team efforts, set performance goals, and ensured compliance with operational targets. Conduct training for data entry personnel, overseeing updates in claims and EMR systems Ezcap. Scored 100% on UHC delegated audits for six consecutive years, maintaining high standards of quality control. Collaborate with stakeholders to address business needs, reduce operational challenges, and ensure compliance.

Organized and maintained the credentialing/privileging of applicants for initial appointment, provisional, and re-appointment in compliance with the defined schedules and meeting the Joint Commission standards. Provided such information to the Credentials Committee to determine the competency of practitioners to provide patient care, medical/clinical knowledge, practice-based learning, and improvement, interpersonal and communication skills, professionalism, and system-based practice. Investigated issues of concern, generated reports, and presented findings to management.Processed requests for temporary privileges and observational status to ensure compliance with established policy and procedures. Collaborated with management to recommend changes in best practices for credentialing and privileging of medical-dental staff ensuring cost effective means in the process of verification of credentials. Assisted with medical-dental staff standing, ad-hoc and special committee meetings. Demonstrated excellent communication skills in preparation of agenda, participation in meetings, and follow-up actions. Maintained and monitored the committee minutes, meeting attendance and provided follow-up.

Job duties include preparing and maintaining reports of credentialing activities such as accreditation, membership or facility privileges. Ensure that all information meets federal and state guidelines when processing applications. Credential and re-credential both employed providers as well as commercial providers in various states.Request admitting privileges at a hospital, process the application to make sure the doctor is eligible; maintain all the records and documentation of the application and verification. Keep a facility's accreditation up to date and assist auditors.

Credentialed various healthcare providers for employment aboard military installations in San Antonio.Verified employment, licensure, and education using primary source verification.Assisted in the process for becoming paperless by scanning all provider files and labeling all documents in company's system.

Credentialed and re-credentialed healthcare providers for the South Carolina Medicaid programMaintained monthly monitoring reports for licensure and disciplinary actions.Assigned work to fellow team members as well as entered new provider applications into Cactus system.

Prepared and maintained reports of credentialing activities such as accreditation, membership or facility privileges. Ensured that all information met federal and state guidelines when processing applications. Credentialed and re-credentialed various mental health providers throughout the United States.

-Maintained and processed beneficiary consults, authorizations, and resultsin the Referral Management 15,000+ member database-Generated weekly reports for the board of directors minimizing and monitoring the costs of medical care for the Department of Defense beneficiaries-Procured office supplies and equipment for six departments maximizing a $30,000budget.-Administered the department safety training on a monthly basis ensuring regulation compliance.-Awarded the Navy and Marine Corps Achievement Medal (NAM) -Leadership training completed